Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 11115 | WI |
NPI | 1003317330 |
---|---|
Provider Name | Mrs. Sherry M Clifton |
First Address | Kenosha, WI 53143-6111 |
Second Address | Kenosha, WI 53143-6111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 22/02/2018 |